The Washington Post National Weekly - April 23, 2017

SUNDAY, APRIL 23, 2017

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‘The emergency room now is the back of an ambulance.’

When a poor community loses its hospital, it also loses its sense of security. PAGE 12

Politics U.S. gives mixed signs 4

Nation Tourism takes a hit 8

Trends Once trash, now it’s food 17

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KLMNO WEEKLY

NATIONAL SECURITY

No U.S. attorneys in place at Justice BY

S ARI H ORWITZ

A

ttorney General Jeff Sessions is making aggressive law enforcement a top priority, directing his federal prosecutors across the country to crack down on illegal immigrants and “use every tool” they have to go after violent criminals and drug traffickers.

But the attorney general does not have a single U.S. attorney in place to lead his toughon-crime efforts across the country. Last month, Sessions abruptly told the dozens of remaining Obama administration U.S. attorneys to submit their resignations immediately — and none of them, or the 47 who had already left, have been replaced.

“We really need to work hard at that,” Sessions said when asked this past week about the vacancies as he opened a meeting with federal law enforcement officials. The 93 unfilled U.S. attorney positions are among the hundreds of critical Trump administration jobs that remain open.

Sessions is also without the heads of his top units, including the civil rights, criminal and national security divisions, as he tries to reshape the Justice Department.

U.S. attorneys, who prosecute federal crimes from state offices around the nation, are critical to implementing an attorney general’s law enforcement agenda. Both the George W. Bush and Barack Obama administrations gradually eased out the previous administration’s U.S. attorneys while officials sought new ones.

Sessions said that until he has his replacements, career acting U.S. attorneys “respond pretty well to presidential

leadership.”

But former Justice Department officials say that acting U.S. attorneys do not operate with the same authority when interacting with police chiefs and other law enforcement executives.

Filling the vacancies has also been complicated by Sessions not having his second-highest-ranking official in place. Rod J. Rosenstein, nominated for deputy attorney general — the person who runs the Justice Department day-to-day — is still not on board, although he is expected to be confirmed by the Senate this month. Traditionally, the deputy attorney general helps to select the U.S. attorneys.

When Obama’s first attorney general, Eric H. Holder Jr., launched an ambitious plan to reform the criminal-justice system, it was the U.S. attorneys on the ground who were in

charge of carrying out his plan to stop charging low-level nonviolent drug offenders with offenses that imposed severe mandatory sentences. Now, Sessions is taking steps toward reversing that policy — without his top prosecutors nominated or confirmed.

Sessions has also created a task force on crime reduction, and one of his first actions was to send a memo last month to his acting U.S. attorneys and assistant U.S. attorneys directing them to investigate and prosecute the most violent offenders in each district. On April 11, he traveled to Nogales, Ariz., where he directed his 5,904 federal prosecutors to make illegal immigration cases a higher priority and work to bring felony charges against those who cross the border illegally.

The U.S. attorney process could be delayed many more months because of what is known as the “blue slip” process in Congress, which dates to the early 1900s. Traditionally, the administration consults with the senators of each state before choosing U.S. attorneys.

Sessions said the Justice Department will ask for help from Congress and “a number of [names] are going over now.” The Senate Judiciary Committee sends a blue piece of paper to each senator to voice their approval or disapproval of a U.S. attorney nominee from their home state.

The attorney general said this past week that the U.S. attorney process “does take some months and has traditionally.” Sessions himself was asked to resign as the U.S. attorney for Alabama in March 1993 by President Bill Clinton’s attorney general, Janet Reno, who, like Sessions, asked all her U.S. attorneys to resign and didn’t begin replacing them for a few months. n

@The Washington Post

Attorney General Jeff Sessions

AARON P. BERNSTEIN/REUTERS

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This publication was prepared by editors at The Washington Post for printing and distribution by our partner publications across the country. All articles and columns have previously appeared in The Post or on washingtonpost.com and have been edited to fit this format. For questions or comments regarding content, please e-mail weekly@washpost.com. If you have a question about printing quality, wish to subscribe, or would like to place a hold on delivery, please contact your local newspaper’s circulation department. © 2017 The Washington Post / Year 3, No. 28

CONTENTS POLITICS THE NATION THE WORLD COVER STORY HISTORY BOOKS OPINION ON LEADERSHIP

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ON THE COVER Paramedic Chris Milton treats Kay Otts, who was in a crash in Brownsville, Tenn. They had to go to a hospital nearly 30 miles away because Brownsville’s hospital was closed. (Photo by MICHAEL S. WILLIAMSON/The Washington Post)

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POLITICS

WHITE HOUSE/AGENCE FRANCE-PRESSE VIA GETTY IMAGES

Sowing confusion on foreign affairs There have been many mixed signals, such as Trump’s split with State over vote in Turkey

BY D AVID N AKAMURA AND K AREN D E Y OUNG

A

s he nears his 100th day in office, President Trump’s efforts to appear decisive and unequivocal in his responses to fast-moving global crises have been undercut by confusing and conflicting messages from within his administration.

Over the past two weeks, policy pronouncements from senior Trump aides have often been at odds with one another — such as whether Syrian President Bashar al-Assad must leave power as part of a negotiated resolution to end that nation’s civil war.

In other cases, formal White House written statements have conflicted with those from government agencies, even on the same day. For example, Monday brought disparate U.S. reactions — supportive from Trump, chiding from the State Department — to the Turkish referendum this past week that strengthened President Recep Tayyip Erdogan’s authoritarian rule.

Even when there is unanimity in the messaging — such as Trump’s boast, based on Pentagon statements, that a U.S. Navy “armada” was headed toward the Korean Peninsula — the administration was forced into the embarrassing admission a few days later that the strike group was, in fact, sailing in the opposite direction.

President Trump receives a briefing on the Syria military strike from the National Security team via secure video teleconference on April 6 at the Mar-a-Lago estate in Florida. (The photograph has been edited to obscure the contents of sensitive documents.) Senior officials went on the Sunday political talk shows after the strike and offered conflicting statements on Syrian President Bashar al-Assad’s future.

Although every administration experiences growing pains, the recent succession of mixed signals over key national security issues has stood out, painting a picture to some of an administration that has not fully developed its policies or a broader international agenda and whose key agencies are not communicating with one another — or the White House. It is a situation that has led foreign diplomats and congressional lawmakers to express uncertainty about the administration’s goals and about who is speaking on its behalf.

Former national security officials who served under both Republican and Democratic presidents emphasized that the Trump administration has been hampered by a president who has been slow to ap-

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POLITICS point hundreds of mid-level managers at Cabinet agencies, including the Pentagon and the State Department, and who has at times expressed disdain for the traditional interagency decision-making process.

The result is that the normally meticulous care that goes into formulating and coordinating U.S. government policy positions or even simple statements is often absent. Institutional memory is lacking, these former officials said, and mistakes and contradictions easily slip through the cracks.

“Part of it reflects the fact that these departments are not staffed, and they’re not operating at capacity or at speed,” said Stephen J. Hadley, who served as President George W. Bush’s national security adviser. “These Cabinet secretaries are kind of home alone, working with people that they really don’t know. They don’t have their own people in place, their policies in place, or processes in place yet.”

Inside Trump’s National Security Council, the agency charged with coordinating foreign policy decision-making and consistent messaging, the disarray has been palpable. Trump’s first choice for his national security adviser, Michael T. Flynn, was forced out amid revelations that he had misled senior officials, including Vice President Pence, about his communications with Russian officials before Trump took office.

Beyond his difficulties with the Russia issue, Flynn was unable, in the few weeks that he presided over the NSC staff, to establish a smooth decision-making process that could rationalize the often widely disparate views of Trump’s key White House advisers and new Cabinet members. His replacement, H.R. McMaster, moved quickly to consolidate power by pushing out Trump’s senior strategist, Stephen K. Bannon, who had initially been awarded a seat on the NSC “principals committee.”

McMaster has sought, with incomplete success, to exert more control over staffing and to establish a more disciplined process in place of what had been a largely ad hoc system. In the wake of Trump’s decision to authorize missile strikes on a Syrian airfield as retribution for the Assad regime’s use of chemical weapons, McMaster said that the administration had held several NSC meetings, including with Trump aboard Air Force

AARON P. BERNSTEIN/REUTERS

One and at his private Mar-a-Lago resort in Florida, to develop and coordinate the military operation.

Yet those efforts were to some degree undermined when senior officials went on the Sunday political talk shows after the strikes and offered conflicting statements on Assad’s future. Secretary of State Rex Tillerson said the administration’s top goal was defeating the Islamic State, while Nikki Haley, the U.S. ambassador to the United Nations, said no resolution to the Syrian civil war was possible with Assad in power.

“Public diplomacy is a huge tool, presenting a united front, presenting a shared vision of how you approach global affairs — everything from the use of military force to sanctions,” said Jennifer Psaki, who served as the White House communications director and as a State Department spokeswoman under President Barack Obama. “When you have officials stating conflicting viewpoints, you’re sending a confusing message — not just to people in this country and to Congress, but confusing and conflicting messages to partners and allies around the world.”

Trump aides disputed the suggestion the administration was speaking with more than one voice. Michael Anton, the director of strategic communications at the NSC, said there was “nothing inconsistent” about the White House’s Syria policy.

“Defeating ISIS has always been

the paramount goal, and nobody ever envisioned a long-term future for Assad,” Anton said, using an acronym for the terrorist group.

Most of the public statements made by the agencies are vetted through Anton’s office before they are released, he said.

But there is no permanent spokesman at either State or the Pentagon, making it difficult to keep up with the deluge of requests from reporters. Anton has three aides, while Obama’s NSC had up to seven people in the same division, according to former Obama aides.

This past week, the Trump White House appeared to be on a different page than the State Department in the wake of the Turkish referendum that greatly expanded Erdogan’s powers.

While the State Department emphasized the United States’ interest in Turkey’s “democratic development” and the importance of the “rule of law and a diverse and free media,” the White House statement said Trump had called to congratulate Erdogan and discuss their shared goal of defeating the Islamic State.

Anton said the statements were not in conflict, citing a “tension in U.S. policy goals.”

“You want to keep a NATO ally, a partner in the strategic fight against ISIS,” he said. “You also have a national interest in democracy in Turkey. . . . Sometimes foreign policy requires making difficult choices and balancing inter-

President Trump, seen in the White House on Thursday, has been slow to appoint hundreds of mid-level managers at Cabinet agencies, which former national security officials say has hampered the administration.

KLMNO WEEKLY

ests that are in tension.”

While some analysts spoke approvingly of a “good cop, bad cop” approach, none seemed sure whether that is what the administration had intended.

Outside experts said there were budding signs of maturation within the administration. They cited the decision-making process on the Syrian strikes and the summit between Trump and Xi Jinping at Mar-a-Lago this month.

Former officials and foreign policy analysts viewed some of the administration’s policy reversals — including its renewed support for NATO and tougher tone on Russia — as the natural evolution from inexperience and lack of knowledge to confrontations with reality.

Still, events of the past week have raised concerns about consequences in a volatile world, where such missteps can be costly.

The administration’s erroneous statements about the location and direction of the USS Carl Vinson — an aircraft carrier that officials said was dispatched to the Korean Peninsula as a show of force against North Korea’s belligerence — were widely viewed as a simple “screw-up,” in the words of several former officials.

While administration officials said the goal was to reassure regional partners, South Korea expressed concern over a possible bait and switch, and China warned against escalation.

White House press secretary Sean Spicer insisted Wednesday that the White House had said nothing incorrect, since the ship is now — more than a week after it was announced — apparently on its way toward the Korean Peninsula.

To those who worked in the Obama White House, the disarray has led to a sense of vindication about their own strategy after years of being accused by political rivals of micromanaging the agencies.

“Success of a policy in some cases resides as much in the nuance of the messaging as it does in the policy,” said Bernadette Meehan, who served as the NSC spokeswoman under Obama. “You explain it, get people to buy in, rather than stoking up fears unnecessarily. It’s incredibly important if you want a policy to have success to have cohesive messaging.” n ©The Washington Post

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POLITICS

In advice to Trump, industry targets the EPA BY

J ULIET E ILPERIN

J

ust days after taking office, President Trump invited American manufacturers to recommend ways the government could cut regulations and make it easier for companies to get their projects approved.

Industry leaders responded with scores of suggestions that paint the clearest picture yet of the dramatic steps that Trump officials are likely to take in overhauling federal policies, especially those designed to advance environmental protection and safeguard worker rights.

Those clues are embedded in the 168 comments submitted to the government after Trump signed a presidential memorandum Jan. 24 instructing the Commerce Department to figure out how to ease permitting and trim regulations with the aim of boosting domestic manufacturing. The Environmental Protection Agency has emerged as the primary target in these comments, accounting for nearly half, with the Labor Department in second place as the subject of more than a fifth, according to a Commerce Department analysis.

Among the notable items on industry’s to-do list: • BP wants to make it easier to drill for oil and gas in the Gulf of Mexico by reducing how often companies have to get their leases renewed.

• A trade association representing the pavement industry wants to preclude the U.S. Geological Survey from conducting what the group calls “advocacy research” into the environmental impact of coal tar. The Pavement Coatings Technology Council says this research could limit what it uses to seal parking lots and driveways.

• The U.S. Chamber of Commerce

wants to reduce the amount of time opponents have to challenge federal approval of projects. Challenges would have to be filed within two years, down from six.

• The Chamber also wants to jettison a requirement that employers report their injury and illness records electronically to the Labor Department so they can be posted “on the internet for anyone to see.”

• And in its 51-page comment, “Make Federal Agencies Responsible Again,” the Associated General Contractors of America recommended repealing 11 of President Barack Obama’s executive orders and memorandums, including one establishing paid sick leave for government contractors.

Three senior administration officials in different departments said the White House is inclined to accept many of these suggestions.

They asked for anonymity to discuss a process that is still underway.

Neil Bradley, the Chamber’s senior vice president, said in an interview that the EPA has led the government in issuing “high-cost, high-impact regulations” that harmed businesses. The Chamber estimated that rules issued under Obama would cost businesses more than $70 billion annually.

“Now, we have an administration who’s interested” in streamlining federal approvals and rules, Bradley said, and is providing relief “from a regulatory onslaught that occurred, principally, during the prior administration.”

Across the government, administration officials are beginning to flesh out how they can scale back rules imposed by Obama — and in some cases, his predecessors. Officials are launching websites to take suggestions, holding meetings with chief executives and industry representatives, and drawing up recommendations to submit to the White House.

DAVID MCNEW/GETTY IMAGES

Commerce Secretary Wilbur Ross is scheduled to submit his report on stimulating domestic manufacturing toward the end of next month.

“This is the first time any administration has canvassed the private sector to find the worst regulatory and permitting problems, and it is axiomatic that you can’t solve a problem until you have identified it,” Ross said, adding that officials were “refining their recommendations” now “to take responsible action. We look forward to working further with American workers and businesses, in manufacturing and other sectors, to unshackle the innovative spirit that made this country great.”

The National Association of Manufacturers began preparing its response the day Trump signed the memorandum, according to Rosario Palmieri, its vice president for labor, legal and regulatory policy. On March 27, NAM hosted a meeting at its offices in which representatives from about 100 companies discussed their recommendations with senior Commerce staff.

“This has a tremendous opportunity to be very successful and result in real burden reductions,” Palmieri said.

More than 80 percent of the comments Commerce received on the presidential memorandum came from trade associations or manufacturers.

The campaign to roll back regulations has sparked concern among liberal advocacy groups and some former Obama administration officials, who said the fed-

Repeal of environmental regulations is high on companies’ wish list The gas-powered Valley Generating Station is seen in California’s San Fernando Valley on March 10. The U.S. Chamber of Commerce estimated that rules issued under President Barack Obama would cost businesses more than $70 billion annually.

eral government must keep longterm consequences in mind as it considers unwinding rules aimed at protecting the environment and workers.

“At a time when many CEOS are focused on the short term and looking to maximize their profitability each quarter, I believe that a lot of their aversion to these regulations reflects a short-term mindset that values reducing costs over anything else,” said Jeffrey Zients, who worked on regulatory matters while holding two top economic posts in Obama’s White House.

Marcus Peacock, who served briefly as a senior White House budget adviser under Trump before joining the Business Roundtable advocacy group, said previous efforts to streamline regulations “have had difficulty sticking as strongly as they should have.”

But several of Trump’s earliest actions could give this latest drive more punch. Trump signed an executive order requiring that many agencies eliminate two regulations for each new one they propose and that these changes entail no increased cost. Another executive order established a regulatory reform officer and task force in each department.

Several business advocates, for their part, say the shift represents a course correction. The National Association of Roofing Contractors wrote in its submission to Commerce, “For years, the Obama Administration consistently refused to address the many concerns of NRCA members when issuing new regulations.” n

©The Washington Post

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Races leave GOP cheering — for now BY

P AUL K ANE

R

epublicans have emerged from two close-call elections rattled but not — yet — defeated, but with fresh, frightening evidence of the additional political peril that almost certainly lies ahead.

Sure, they avoided the calamity of an outright loss in Tuesday’s special election in Georgia, advancing to a runoff race in two months to replace the new health secretary, Tom Price. And when lawmakers return this week, House Speaker Paul D. Ryan’s first order of business will be to swear in the newest House Republican, Ron Estes, after his special election win in Kansas this month.

But both races gave Republicans a scare they never would have anticipated six months ago — and demonstrated that Democrats have galvanized the antiTrump activism of the past three months into votes at the ballot box. Even though Democrats came up short in each race, these were seats way down the list of top Democratic targets. This was particularly true of the Estes race, in a district where Trump won by an overwhelming margin.

Far richer targets await in the 2018 midterm elections.

And in the near term, Republicans find themselves facing the same task — figuring out how to fulfill President Trump’s agenda — that rallied Democrats in the first place.

Democrats believe that Jon Ossoff’s performance in Georgia, coming up less than two points shy of the 50 percent threshold he needed to win outright, validated their emerging strategy of focusing on dozens of GOP seats in diverse, well-educated suburbs across the country in advance of next year’s elections. Price regularly won this seat north of Atlanta without breaking a sweat, but Trump won the region by just 1.5 percentage points last year.

That signaled a potential vulnerability for several dozen Republicans in similar suburban areas, many of whom, like Price, have regularly won reelection by

DAVID GOLDMAN/ASSOCIATED PRESS

Tight special elections give Republicans a scare and Democrats reason to be hopeful in midterms wide margins. Almost all of these Republicans have never run for Congress with a Republican president in office.

They are Republicans like Reps. Lee Zeldin from Long Island and Ryan Costello from Philadelphia’s western suburbs, both elected in 2014, and Reps. Erik Paulsen from the Twin Cities suburbs and Leonard Lance of New Jersey, both elected in 2008. All four won reelection last November in a rout, with Lance’s 11-percentage-point win being the smallest margin of the four.

Now, they are all Democratic targets next year because of the suburban makeup of their districts. Previously they ran as independent checks against a Democratic president whose popularity wavered in those regions, but now they must choose sides: defend Trump or distance themselves from him.

“Even if he doesn’t hit 50 tonight, Ossoff is showing us the path to retaking the House. It runs through the Panera Breads of America,” Brian Fallon, a former adviser to Hillary Clinton’s

presidential campaign and Senate Minority Leader Charles E. Schumer (D-N.Y.), wrote Tuesday on Twitter.

Democrats need a net gain of 24 seats to reclaim the House majority, and Ossoff ’s strong showing heightens the attention on every decision made by Republicans in potential swing districts over the next 18 months.

House Republicans have already backed off one attempt to pass Ryan’s plan to revise the 2010 Affordable Care Act because of a revolt from conservatives and moderates. The House is wrapping up an 18-day break in which some Republicans have faced angry voters at town halls complaining that Ryan’s health-care plan would leave millions uninsured.

Trump has been pushing for more negotiating, and for a vote later this spring. The task was already an uphill fight. Now, after Kansas and Georgia, House Republicans may be even more anxious about voting on the controversial plan.

If Republicans start believing their majority is imperiled, every-

Amy Peil, left, and Ginger Howard cheer as Karen Handel, the Republican candidate for Georgia's 6th Congressional District, speaks at an election night watch party Tuesday in Roswell, Ga. No one won a majority of the votes, so there will be a runoff in June.

thing will grow more difficult.

Each vote brings more doubt from a rank-and-file lawmaker wondering if he or she is walking a plank toward defeat in the midterms.

Legislative paralysis, in turn, could imperil Republican fortunes even more.

Trump came into office with a sweeping prediction that he would win so much that the public would get tired of winning.

Ryan spent last year waving his “Better Way” policy prescriptions, which he promised would become a reality under a Republican Congress and president.

If Republicans don’t push through some parts of Trump’s agenda, they’ll have very little to show voters next year in their reelection bids.

This is a new dilemma for Republicans. Since winning the House during the 2010 midterms, they have behaved as if their gerrymandered districts created a permanent majority. They pushed the U.S. Treasury to the brink of default in 2011, yet only lost a few seats the following year; they forced a government shutdown in 2013, only to expand their majority in 2014 to its largest since the Great Depression.

Fast-forward to this year, when, in the span of one week, Republicans needed a last-minute infusion of cash from conservative groups in Washington to prop up Estes, and when a nearly $5 million barrage of ads against Ossoff did nothing more than keep him from winning outright in a district that has been held by Republicans since 1979. Those GOP groups will probably spend that much and more between now and the June 20 runoff.

Now, Republicans have to decide whether to keep pushing the big and bold plans on health care and an overhaul of the tax code — or whether to pull back the ambition in the hope for some narrower victories.

Each path has its own level of vulnerability, as two straight close special elections have demonstrated. n ©The Washington Post

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NATION

Another ‘lost decade’ for tourism?

BY

A BHA B HATTARAI

T

he cancellations came quickly and in rapid succession. Within days of President Trump’s first executive order restricting travelers from seven Muslim-majority countries, a number of European travel groups pulled their plans, amounting to a loss of 2,000 overnight stays for Hostelling International USA. The ban would complicate travel for citizens of the countries cited — among them Iran, Syria and Libya. But Canadians and Europeans and others were dropping their plans, too. As group organizers put it, people suddenly had an unsettling sense that the United States wasn’t as welcoming a place as it once was.

The result was a wave of withdrawals. “Getting those cancellations all at once, that was startling,” said Russ Hedge, chief executive of HIU, which oversees 52 hostels across the country.

“We’ve never seen something like that.”

From hostels to major hotel chains such as Marriott, tour group operators to outfits that cater to business travelers, the toll of Trump’s proposals on the nation’s tourism industry has been swift. Some say long-term damage has been done.

And it could be compounded by recent reports of Trump administration plans to implement “extreme vetting” of foreign travelers. Visitors — including those from allies such as France and Germany — could be pressed to turn over cellphone contacts, social media passwords and financial records, according to a Wall Street Journal report.

“The travel ban is only a negative at this point,” said Michael Bellisario, an analyst for the investment bank Robert W. Baird & Co. “It hurts travel, regardless of whether we’re talking about one of the six banned countries or not,” he said, referring to the second, revised entry ban.

Demand for flights to the United States has fallen in nearly every country since January,

JUSTIN SULLIVAN/GETTY IMAGES

Trump’s proposed travel ban and other plans are dealing a blow of billions of dollars to the industry according to Hopper, a travelbooking app that analyzes more than 10 billion daily airfare price quotes to derive its data. Searches for U.S. flights from China and Iraq have dropped 40 percent since Trump’s inauguration, while demand in Ireland and New Zealand is down about 35 percent. (One exception: Russia, where searches for flights to the United States have surged 60 percent since January.)

The result could be an estimated 4.3 million fewer people coming to the United States this year, resulting in $7.4 billion in lost revenue, according to Tourism Economics, a Philadelphia-based analytics firm. Next year, the fallout is expected to be even larger, with 6.3 million fewer tourists and $10.8 billion in losses. Miami is expected to be hit hardest, followed by San Francisco and New York, the firm said.

The administration’s travel ban deals a blow to an industry that has only recently recovered from a $600 billion loss after the Sept. 11, 2001, attacks.

“In the aftermath of 9/11, at first people didn’t feel safe coming here, and then they didn’t feel welcome,” said Jonathan Grella, an executive vice president at the U.S. Travel Association. “Our industry still refers to that as ‘the lost decade.’ There is a very real risk that that could happen again.”

As anecdotal evidence mounts, industry experts say it’s increasingly clear that travelers from all over — Canada and Mexico, Europe and Asia — are rethinking their plans to visit the United States.

Marriott International, the world’s largest hotel chain, has noted a 15 percent drop in bookings from Mexico to the United States. Meanwhile, bookings from the Middle East to the United States fell about 30 percent in February. The strong dollar, executives said, contributed to a decline in international travel to the United States.

Mike McCormick, executive director of the Global Business Travel Association, said that after

In January, flight attendants at Los Angeles International Airport watch a protest of the U.S. entry ban.

An estimated 4.3 million fewer people are coming to the United States this year, resulting in $7.4 billion in lost revenue, according to the firm Tourism Economics. It’s expected to be worse next year.

Trump’s first travel order, there was a “pronounced drop in bookings,” resulting in estimated losses of $185 million.

“It hurts the industry,” he said.

“You have discretion in moving meetings and events to other places. They don’t have to be in New York or Chicago or here in the U.S.” At Hostelling International, among the first to cancel was a British-based youth group that had planned a trip for 400 to the East Coast this summer. The three-week gathering, called Merit360, was to culminate in presentations to the United Nations.

But then Trump issued his first travel ban. Nearly 80 citizens of the affected countries had already paid their deposits for the annual trip. The year before, when Barack Obama was president and there were no such bans in place, nearly 200 of the organization’s 550 participants had failed to acquire proper visas for their trip. This year was bound to be much worse.

“This has been a setback on so many levels,” said Marlou Hermsen, chief operating officer of World Merit, which oversees the program. “When the first ban was announced, that’s when we thought: It’s real. We’re not welcome anymore.”

Two-thirds of participants voted to move the gathering to Britain, with plans to meet with Parliament in London instead of the United Nations in New York.

Grella, of the U.S. Travel Association, says it’s not so much the executive orders that bother him, but the fact that the U.S. government hasn’t made an effort to reassure international travelers.

“All it takes is a little rebranding: ‘Here’s who’s no longer welcome for the time being, but for everybody else, yes, we’re open for business,’ ” Grella said. “The ripple effects of this are very real.

We’ve unnecessarily ruffled a lot of feathers.”

Since Trump announced the ban, Marie Aguado has canceled three trips: business travel to Los Angeles, a visit to see her brother

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NATION in Austin and a family vacation to Disney World.

“We’re afraid to leave,” said Aguado, an American who lives in Mexico City with her French-born husband and two daughters. She asked to be identified by her middle and last names for fear of government retribution.

“I’m dead serious about not going home,” she said. “When the ban happened, I was thinking of my children.”

Aguado’s oldest daughter was born in Dubai. The other was born in Mexico City. Both are also French citizens.

“I was just thinking they’re going to see my daughter was born in the Middle East,” she said.

“And then what’s going to happen? I got totally freaked out and said to my brother, ‘I’m not coming to see you anymore. Come see me.’ ” Just one more wrinkle, she said: Her brother’s wife is a greencard holder from Ukraine.

“They’re afraid to travel, too,” Aguado said.

That fear of leaving — and re-entering — the United States has led to a slowdown in traffic to Mexican border cities, which have long been popular destinations for shoppers and those seeking cheaper health care.

Carlos Jimenez Robles, the president of the chamber of commerce in the border town of Nogales, said that the number of shoppers crossing into Mexico had dropped by 40 percent.

“We have seen a hardening by border agents, where they have more questions for people, more doubts about who people are,” Jimenez said. “Not only with tourists, also with American citizens.”

Not everybody reported an immediate slowdown in business.

Small World Vacations, a travel agency in New Jersey that specializes in Disney vacations, hasn’t noticed much of a drop-off, either.

It has received just one cancellation this year, from an Iranian American with a German passport. He didn’t want to leave on a Disney cruise to the Bahamas out of fear he wouldn’t be allowed back into the country, said Sue Pisaturo, the agency’s founder.

“We do get our share of international travelers from every country — even countries I’ve never heard of — but so far it’s business as usual,” she said. n ©The Washington Post

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At the Golden Gate Bridge, an effort to halt jumpers BY

S AMANTHA S CHMIDT

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he Golden Gate Bridge is among the most photographed bridges in the world, recognized internationally as a majestic symbol of San Francisco, and the United States.

But for decades, and for scores of mourning families, the bridge has also become a symbol of pain.

In 2016, 39 people died jumping off the bridge, considered one of the top suicide magnets in the world. Another 184 came to the bridge intending to harm themselves but were stopped.

The deaths have scarred the bridge’s reputation and prompted local officials, lawmakers and families of those who died to call for the construction of barriers to deter people from jumping off the 220-foot-tall bridge.

“At that moment, there’s really no way out,” said Sarah Lockwood Barr, 26, whose childhood friend jumped off the bridge in 2008. “It’s just too easy and too final.”

For about a decade, officials have debated constructing such an obstacle, confronting a question that has been researched and scrutinized around the world: Do barriers to suicide stop people from taking their lives? Or will suicidal people simply find another alternative?

A wealth of studies and findings have supported an optimistic view. And the years-long effort finally culminated this month in an official launch of the construction of a $200 million stainless steel net along the bridge. The suicide deterrent system will span 1.7 miles of roadway on each side and will be located 20 feet down from the sidewalk, extending 20 feet out over the water. It will be built over four years, with an expected completion date in 2021.

In May, contractors will begin installing temporary fencing along the bridge and will being making measurements to manufacture the net.

In a commemoration ceremony on April 13, Rep. Nancy Pelosi (DCalif.) said the deterrent would

ALAN DEP/MARIN INDEPENDENT JOURNAL VIA ASSOCIATED PRESS

John Brooks, who lost his daughter Casey to suicide at the Golden Gate Bridge in 2008, attends a ceremony for a suicide barrier on the bridge.

provide a “critical second chance, maybe more than that” for those acting on “impulsive thoughts.”

“People would say to us, ‘Isn’t that a lot of money for a barrier? For a net?’ ” Pelosi said of the project, which initially was estimated to cost $76 million and now has a price tag of over $200 million. “And I would say, ‘No it’s not a lot of money for a life. For all of these lives.’ ” Officials hope the net, made of thick steel cables, will deter people from jumping in the first place. If they jump, they’re likely to survive but with injuries. The net, suspended from posts, will have a slightly upward slope, and will collapse a bit if someone lands in it, making it difficult for the jumper to climb out, The San Francisco Chronicle reported. The bridge district would use a retrieval device to pluck jumpers from the net.

Similar deterrent systems have been used successfully in various locations around the world, but never on this scale, bridge officials said in a news release. In support of such suicide deterrents, many have cited a breakthrough 1978 study at the Golden Gate Bridge showing that 90 percent of those stopped from jumping did not later die by

suicide or other violent means.

For someone like Lockwood Barr’s childhood friend, Casey Brooks, such a barrier could have made all the difference, she said.

Casey Brooks, 17, was halfway through her senior year and already accepted into college when she jumped off the Golden Gate Bridge in January 2008. “She had every reason to live,” Lockwood Barr, told The Post. “It was a complete shock.”

As much and as long as Casey struggled internally, Casey’s final act happened much too quickly, Lockwood Barr said.

After Casey’s death, Lockwood Barr, also 17 at the time, approached her town council in Tiburon, outside San Francisco, in an attempt to create a resolution for a suicide barrier on the bridge, among the first resolutions of its kind. With the help of many others, including Casey’s parents, the resolution passed. It contributed to a groundswell of support for the deterrent, Lockwood Barr said.

“The barrier buys time,” she said. “Time is what allows a person to see that there will be another day.” n ©The Washington Post

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A leftist soars as France goes to polls J AMES M C A ULEY Lille, France BY

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specter is haunting Europe — the specter of Jean-Luc Mélenchon.

In the latest plot twist in France’s highly contentious presidential election, Mélenchon — an outspoken 65year-old leftist who often appears on the campaign trail via hologram and who has pitched his proposal to nationalize France’s biggest banks and renegotiate its relationship with the European Union via free Internet games and YouTube videos — has been soaring in the polls. His meteoric and unexpected rise was already sending jitters through financial markets and shock waves through an increasingly anxious electorate.

For months, analysts have likened today’s French election to “Europe’s Stalingrad,” a crucial turning point that will determine the future of a country and a continent. But while commentators worldwide have focused on the steady rise of the far-right, fiercely anti-immigrant National Front of Marine Le Pen, few have paid any attention to the leftist fringe of Jean-Luc Mélenchon, who has vaulted into the picture recently and who shares with Le Pen the desire to drastically alter France’s relationship with the E.U., the 28state bloc it once designed.

Mélenchon is running as the candidate of the Unbowed France political movement, in an alliance with the French Communist Party.

The latest polls show him narrowly trailing Emmanuel Macron, long seen as the favorite, and Le Pen, expected to qualify for the final round of the two-round vote but to lose to Macron in the final.

However, analysts say Thursday’s shooting, in which one Paris police officer was killed and two others were injured in an attack quickly claimed by the Islamic State, could help right-wing, anti-immigrant candidates such as Le Pen. But Mélenchon’s unexpected surge recently has been a reminder that radical change is in the air, and that its extremist apostles — right or left — may soon hold power.

FREDERIC SCHEIBER/EUROPEAN PRESSPHOTO AGENCY

Mélenchon’s surprise surge in popularity adds to an air of change ahead of today’s election Some have reacted with panic: Investors have begun frantically selling off French bonds, while the head of France’s largest trade union has decried what he described as Mélenchon’s “rather totalitarian vision.”

But thousands of others have responded with joy.

Nearly 25,000 people assembled in this predominantly middle-class northern French city recently to hear Mélenchon, dressed in his signature Mao jacket, take the stage. With his distinct wit, erudition and rhetorical flair, he charmed his crowd, packed inside and outside a local sports arena, waving communist banners, Palestinian flags and signs adorned with the Greek letter “Phi,” the campaign’s official symbol.

“It’s the people who make history,” Mélenchon said, standing on a dais before thousands. “It’s you!

So we have to do it. Let’s go, folks!

Courage!”

Perhaps more than any of the other candidates, it is Mélenchon who best represents 2017’s poten-

tial rupture with history, or at least the status quo. Central to his platform is the promise to abolish France’s Fifth Republic, the system of government established by Charles de Gaulle in 1958.

What Mélenchon detests in this style of government is its monarchical presidency — designed for de Gaulle — which can dissolve parliament at will and has few checks and balances on its power.

Mélenchon has pledged to found what he calls the “Sixth Republic,” a vision that would “take us out of this presidential regime, notably with proportionality in all elections.”

It is an idea that resonates widely — even among those who do not necessarily support Mélenchon’s other more radical proposals, including taking France out of NATO and imposing a 100 percent tax on all income earned over 400,000 euros ($425,000).

“He’s the only one who dares to say it, but there are so many others who agree with that,” said Jacques Bruley, 25, an engineer with Lille’s tram system. Bruley said he was

Jean-Luc Mélenchon, an outspoken 65year-old leftist, wants to limit presidential powers in France. He also wants to nationalize the country’s biggest banks and renegotiate France’s relationship with the European Union.

not a full Mélenchon supporter and had not yet decided whether he would vote for him, but that this particular idea was an imperative.

“There’s one person who holds an unconscionable amount of power. It’s wild,” he said of the presidency. “And when you talk about ‘change,’ it’s Mélenchon who would really bring that kind of big change.”

The reality is that “big change” is likely to come, with or without Mélenchon: For the first time in the history of the Fifth Republic, neither the socialists nor the republicans — the vaguely center-left and center-right parties, respectively, that have governed France since 1958 — are likely to triumph at the ballot box.

The contest will probably be a faceoff between two political outsiders: the independent Macron, the far-right Le Pen, and, possibly, Mélanchon.

Despite their ideological opposition, there are certain similarities between the platforms of Le Pen and Mélenchon. Both favor versions of economic protectionism to bolster a strong French state, and both would ultimately like to see France exit the E.U. — albeit for difference reasons. Le Pen sees Europe as a threat to France’s sovereignty and national identity; Mélenchon views Europe as an oppressive neoliberal regime that has forgotten the poorest members of society.

He proposes renegotiating France’s membership in the bloc, and if things don’t go his way, leaving altogether.

In recent months, Mélenchon — once a distant afterthought in the constant election predictions — has presided over a digital campaign that has successfully appealed to a wider base of voters, especially among the young.

Even so, if young people in France affiliate with a party, it is generally the party of abstention.

According to a recent poll from the Ifop agency, the intent to abstain has risen to 52 percent among voters ages 18 to 25.

Heading into today’s election, the field is wide open. n

©The Washington Post

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WORLD

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Soviet-era homes meet wrecking ball A NDREW R OTH Moscow BY

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he Soviets built Margarita Smurova’s five-story apartment building — and tens of thousands more like it — with an expiration date that’s long since passed.

She thinks the building is still in fine shape and could last a few more years, but Moscow has different plans.

Look out her window and you’ll see what those are: two identical apartment houses razed, a mountain of debris left scattered as if in the wake of a hurricane or bomb blast.

Nearly all of Smurova’s neighbors have left, but she’s holding out, unsatisfied with the replacement apartment offered to her by the government (her mother is in a wheelchair) and is battling the city in court. Meanwhile, the gas to the building has been cut.

Thieves are looting the vacant apartments.

“I really think the city is trying to kill its own people, evicting them like this,” she said, walking up the stairs into an abandoned fifthfloor apartment with a balcony overlooking the wreckage.

For Smurova’s parents, who moved into this building from a communal apartment in 1965, it was a chance for a new life with privacy at home and green public spaces outside. Today, the “khrushchevka,” named for the former Soviet leader who ordered its earliest design, is better known by Russians as a symbol of aging Soviet-era infrastructure.

“I love my five-story house; it’s practically a pathology,” joked Tatyana Chaynikova, 68, Smurova’s neighbor. “After my husband died, I put everything I had into this apartment. And now that they’re moving me out, what will I have left?”

In 1954, the Soviet Union under Nikita Khrushchev began what may have been the largest urban development project in history. Facing a severe housing shortage and a booming postwar population, the communist lead-

MAX AVDEEV FOR THE WASHINGTON POST

A massive urban demolition project in Moscow brings resistance from some longtime residents er commissioned a prefabricated apartment house that would transform the country. By the time he was ousted from power in 1964, as many as 54 million Soviet citizens — a quarter of the population — had moved into new apartments, a number that would grow to more than 127 million in the five years that followed. In 1961, for the first time, the Soviet Union’s urban population surpassed its rural population.

Cutting-edge for their time because they were quick and cheap to build, but also because of the effort to include green space around them, the apartments were not known for their aesthetic appeal. Some early versions were built with cheaper materials meant to last only 25 years, or until the Soviet Union had successfully built communism and would replace them with something better.

“We are not against beauty; we are against superfluity,” Khrushchev said, ordering state architects to try to make them as pleasing as possible, given their

limits.

Now, in Moscow, their time is up. Mayor Sergei Sobyanin in February announced what may be history’s largest urban demolition project, eliminating nearly 8,000 buildings, mostly five-story building stock including structures built under Khrushchev, in a resettlement project that will ultimately transplant 1.6 million people.

Smurova’s apartment building, which has just been slated for demolition under a project approved in 1999, shows how messy those disputes over housing can become in Russia.

The project is part of a sweeping, although contentious, change for many Muscovites, whose city is growing wealthier even as it is run by an administration that rarely seeks public consensus before launching large beautification projects such as parks and road works.

Critics say it’s a handout to Russian property developers.

“I know the mood and expectations of Muscovites,” Russian President Vladimir Putin told

Tatyana Chaynikova wants to stay in her condemned building: “After my husband died, I put everything I had into this apartment. And now that they’re moving me out, what will I have left?”

Sobyanin during a televised meeting in February, greenlighting the project. “They expect these buildings to be torn down and new housing to be built in their place.”

Some are happily bidding farewell to aging apartments, known for their low ceilings, thin walls and faulty plumbing.

But khrushchevki were a major step forward for urban planning, said Kuba Snopek, a Polish architect who did research in Russia and wrote a book called “Belyayevo Forever” about the importance of self-contained, mid-century Soviet housing developments called “mikrorayony,” or microdistricts, which regulated urban expansion by ensuring access to green spaces, public transportation and municipal buildings.

“It’s very easy to communicate the flaws of this architecture,” said Snopek, who sought to have Belyayevo, a region of Moscow, put on the UNESCO World Heritage List.

“It’s vulnerable because it is ugly and doesn’t look precious. But it’s hard to communicate its values, because they’re invisible.”

When they first appeared, the apartment buildings were hailed as a revelation. But Russian attitudes toward the prefab housing grew darker in later years, particularly as the apartment buildings grew larger and the infrastructure decrepit.

Nowadays, these Soviet buildings have become shorthand for working-class neighborhoods.

But love them or hate them, residents worry about getting decent new apartments if their old ones are torn down. Some are organizing for a legal and political battle.

“We owners are not going to just give away our apartments for what they give us,” said Kari Guggenberger, an IT developer who also runs a Facebook group called “Muscovites against the demolition.”

“In two months, there are going to be lists of houses to be torn down. So in two months, there’s going to be a storm.” n ©The Washington Post

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COVER STORY

Rural America’s dying hospitals A Tennessee town loses its major medical facility, forcing residents to rely on long ambulance rides — if they seek help at all A MY G OLDSTEIN // PHOTOS BY M ICHAEL S . W ILLIAMSON in Brownsville, Tenn.

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his town of the Tennessee Delta, seat of a county that once grew the most cotton east of the Mississippi, relied for decades on a little public hospital built during the Great Depression a few blocks from the courthouse square.

The red-brick building was knocked down in the 1970s when a for-profit chain came along and opened a modern stucco hospital on the north side of town. There, thousands of babies were born, pneumonias and failing hearts were treated and the longtime family doctor across the parking lot could wheel the sickest patients who arrived at his office right into the emergency room.

But these days, plywood boards are nailed up behind the hospital’s sliding glass entrances. Black paint is smudged across signs over its doorways. The nearest ER is more than a half-hour ambulance ride away.

The demise of Haywood Park Community Hospital three years ago this summer added Brownsville to an epidemic of dying hospitals across rural America.

Nearly 80 have closed since 2010, including nine in Tennessee, more than in any state but Texas. Many more are considered fragile — downstream victims of federal health policies, shifts in medical practice, and the limited tolerance of distant corporate owners for empty beds and financial losses.

In every rural community, the ripple effects of a lost hospital are profound, reverberating beyond the inability of would-be patients to get immediate care.

Many of the best jobs in town vanish. Local leaders trying to recruit new industry face an extra hurdle.

Haywood County’s budget has become a twisted mess as demand for the services of its ambulance authority has ballooned. “The emergency room now is the back of an ambulance,” said Bill Rawls, who grew up in Brownsville and was sworn in as its first black mayor the month the hospital closed.

The town he leads is the epicenter of a dead-hospital zone in west Tennessee. Twenty-six miles nearly due continues on next page

The McNairy Regional Hospital in Selmer, Tenn., sits empty now. The closures of Haywood Park Community Hospital and others in west Tennessee have created a deadhospital zone. Nearly 80 small rural hospitals have closed nationwide since 2010, and many more are considered fragile.

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COVER STORY Natalie Pinner believes her son, Clayton, now 4, would have died if they hadn’t been able to go to the hospital in Brownsville after Clayton had a severe allergic reaction when he was 15 months old. She prays for the safety of the town now that the hospital has closed.

Brownsville Mayor Bill Rawls still remembers the day he had to order the hospital location signs removed from Interstate 40 so that travelers would not continue to think that emergency care was available in the town. He and the mayor of Haywood County have been struggling to bring at least an emergency room back to Brownsville.

from previous page

south, the Methodist Fayette Hospital in tiny Somerville shut down eight months after Haywood Park.

“This facility is permanently closed,” signs on its doors say. “Dial 9-1-1 in the event of an emergency.”

The old operating room has been rented out for movie shoots.

About 60 miles southeast of Brownsville, McNairy Regional Hospital in Selmer closed last May. Vestiges of its care — a gurney, an IV pole, a crash cart — are strewn in the hallway near what was the emergency room. And within an hour to the north, Humboldt General Hospital and Gibson General Hospital also closed. Some outpatient services have come back at both — but no hospital beds.

Brownsville’s hospital enjoyed a special legacy. When the original opened in 1935, a gift from a man who made his fortune in Nashville to his home town, Haywood County became one of the first poor counties in Tennessee with its own hospital. Today, the county remains so tied to its agriculture that family pictures are still taken in cotton fields. Its poverty also persists. More than 1 in 5 of the 18,000 people here live below the poverty line, with familiar consequences. Haywood ranks 90th out of Tennessee’s 95 counties for health, with obesity and diabetes especially common.

Together with Franklin Smith, Haywood County’s mayor for most of the past three decades, Rawls is struggling to bring at least an emergency room back to Brownsville. In his office in the small city hall adjacent to the fire department, he has a letter from a woman whose 8-year-old nephew was playing in the family driveway on a late winter morning last year when their Dodge sedan rolled backward, pinning him under a tire.

Without a hospital in town, she explained, “needless to say he did not make it.”

It is not rare for people to tell the mayor such stories, but this one came in writing, and he keeps it on his desk within eyesight.

“What do you do about this?”

Rawls asked. “It’s a heavy burden.”

Why the hospital closed On a spring day in 2014, Smith got a call from Haywood Park’s administrator hours before the official announcement. The hospital’s parent company, Community

Health Systems of Franklin, Tenn., had filed paperwork with the state to shut it down in 90 days.

The news was stunning and abrupt but not a total surprise. For years, Haywood Park had been hemorrhaging patients and money. It had been years since an obstetrician was on staff, so babies were no longer being delivered.

And as treatment for heart attacks, strokes and other life-threatening ailments had become more sophisticated, the hospital had become accustomed to stabilizing patients, then sending them by ambulance for more specialized care at Jackson-Madison County General Hospital, nearly 30 miles away. Eventually, more and more patients decided to skip the first stop and head directly to Jackson.

The year before it closed, 62-bed Haywood Park admitted 245 patients — down from 917 three years before, according to data filed with the state. Dwindling popularity was not the only reason for the drop.

Federal officials who oversee Medicare had started sending auditors to make sure all hospital admissions were warranted, and hospitals did not want to risk admitting patients for whom they might not get paid. Then a new rule prompted hospitals to place more older patients on “observation status” for brief stays — put in beds but not officially admitted, which meant lower government reimbursement.

One other financial blow: The Affordable Care Act curtailed hospitals’ Medicare payments on the theory that more patients would be insured. Even if the law disappears, predictions vary on whether Republican health-care proposals being contemplated in Washington would help or hurt.

The Affordable Care Act has not gained much ground here. In 2016, 664 Haywood County residents bought health plans through its marketplace for people without coverage through a job. By one estimate, 2,200 residents would qualify for Medicaid benefits if Tennessee expanded the program under the law; the Republican governor tried but was rebuffed by the more conservative legislature.

Near the end, more than a quarter of Haywood Park’s charges were for “self-pay” patients who lacked health insurance. Haywood Park’s losses grew from $4.2 million in 2010 to $6.6 mil-

“What do you do about this?

It’s a heavy burden.”

Brownsville, Tenn., Mayor Bill Rawls, above

lion in 2013, the data show.

“They tried everything to keep it open,” said Clarey Dowling, who arrived in Brownsville in 1980 as a fledging family practitioner and never left. Over the years, he was Haywood Park’s medical director and a member of its board, and the staff knew it was lunchtime when he walked across the parking lot from his office to the hospital each weekday to check on patients.

When the hospital closed, Community Health Systems announced it would keep an urgent care center there. Dowling added Wednesday afternoon and Saturday morning shifts to his work schedule to help out. Yet five months later, the company announced that the urgent care was not drawing enough patients. By the end of January 2015, it was gone, too.

Prayer in the parking lot On the morning of the hospital’s last day, Natalie Pinner drove to its parking lot, turned off her car and prayed.

Exactly a year earlier, she had been with her parents, who live next door along a country road that bears the family name. Her father and husband were grilling.

She was in the kitchen with her mother, a sister and her son, Clayton. It was 5 p.m., and the 15-month-old was hungry, so she gave him some peanut butter on a cracker. He touched it to his lips, not even taking a bite, and red welts immediately popped out on his face. He started gasping for air.

Her sister, a nurse, knew they needed to get the little boy to the hospital, pronto. They piled in the car and, blaring the horn and flashing the lights as if it were an

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favorite recliner when his wife looked over and noticed that his smile was crooked. Immediately fearing a stroke, she asked her husband to raise his arms, right and then left. His left arm would not move.

By the time the ambulance answered the 911 call and got Charles Cozart to the Jackson hospital, his carotid artery was 100 percent blocked. He was there for a week, then at two facilities for rehabilitation, before finally coming home in December.

“My left arm isn’t doing anything,” Cozart, 73, said late last month. “I can walk a little, but it’s kind of slow.”

The typical ambulance call, 30 minutes when the hospital was open, is now 2½ hours. ambulance, raced the eight miles to Haywood Park in less than six minutes. Clayton’s eyes were rolled back as Pinner ran in with his limp body. The ER doctor said his airway was closed and his oxygen level so low that he might not survive. But shots of epinephrine gave the staff enough time to summon a medical helicopter that flies the most desperately ill or injured patients to Memphis, about 60 miles away.

Pinner, a part-time teacher, believes her son would have died if they had had to drive to Jackson.

When she heard the news about Haywood Park, she sent letters that begged the staff to keep it open. And when that failed, she marked the anniversary of Clayton’s emergency by praying for the safety of her town.

Some effects of the hospital’s

absence are inconveniences that nonetheless matter. Crestview nursing home in Brownsville often has to scramble when frail residents must be taken to the dialysis center down the street. The ambulances are usually too busy.

Other events are crises. Phyllis Cozart worked at Haywood Park for 21 years and was its human resources manager when it closed.

Last August, on a humid, 100degree morning, she and her husband were working in their garden when Charles collapsed. If the hospital were still there, she thought, she could have forced him to go to the emergency room.

But he refused to go to Jackson and miss an afternoon of golf. By lunch, he seemed to be okay. He headed out.

It would be his last golf game. At 8:30 p.m., he was sitting in his

A mayor’s efforts For such a small, obscure place, Haywood County has a rich heritage. It stands out in civil rights history as the place where the first NAACP member was found murdered. During the 1960s, it was the site of “tent cities” erected by black tenant farmers evicted from their land by white owners for attempting to vote.

In cultural history, the area is the childhood home of singer Tina Turner, author Alex Haley and blues pioneers including “Sleepy” John Estes.

It was that spirit — of managing to make something from nothing — that fueled the determination of Brownsville’s leaders to replace the shuttered hospital or at least reclaim an emergency room.

Smith, the county mayor, and Rawls, his city counterpart, met with several health-care systems in Memphis.

So far, they have been rejected.

A year after Haywood Park closed, Rawls started a program he dubbed “Healthy Moves.” It urges Wednesday night Bible study groups to do five laps around their churches, encourages baked chicken — not fried — at funerals and promotes morning walks around the high school track with a local radio DJ. If Brownsville cannot depend on a hospital, the mayor figures, its people have to become healthier so they need less care.

And as it became clear that no bigger hospital system was interested in the area, a county task force went to Nashville to meet with a lawyer specializing in health care. The only solution, the lawyer advised, was to expand the ambulance service to help get pa-

tients out of town.

Despite their strapped budget, the county commissioners added seven paramedics and advanced emergency medical technicians.

Haywood went from two ambulances available at any given moment to three.

The typical call, 30 minutes when the hospital was open, is now 2½ hours. Even with the extra ambulance, there are times when all are on runs outside the county.

A woman who fell and broke a hip not long ago waited in her driveway for an hour.

David Smith, the ambulance authority’s director, had expected such complications.

What he had not anticipated was how many people would call an ambulance, be treated in their driveways and then refuse to be taken to Jackson or Memphis. The ride is “a one-way ticket,” as one paramedic put it. That’s a deterrent; patients have to find their own way home.

But unless a patient is transported, neither Medicare nor Medicaid will pay for the ambulance run. The ambulance authority sends out bills, but in such a poor county, “there is no way to turn them over to collections,” Smith said. Some people bring in $5 or $10 when they can. In 2016, the ambulance service wrote off more than $1 million in unpaid charges.

“It has broke this county,” he said.

With no hospital in Haywood and 535 square miles to cover, the crews have been stepping up their protocols. They can insert chest tubes, start intravenous antibiotics and intubate patients to help keep airways open.

This move toward more advanced care in the back of ambulances is a reason the Tennessee Ambulance Service Association named Haywood County’s emergency service the best in the state in January. The imposing cutglass trophy was bittersweet.

It arrived as the county mayor was losing a battle with the county commissioners to raise taxes for a third straight year — to prop up the budget that the 911 calls have been eating away.

So the county is cutting the ambulance service staff. By July, the number of ambulances at the ready will go back from three to two. n ©The Washington Post

Charles Cozart has limited use of his left side after a stroke, which did more damage because of the delay he encountered getting medical care. He had to travel to Jackson, Tenn., because the local hospital was closed.

Jeff Russell, left, and Chris Milton head back to their ambulance between calls after getting some coffee at a convenience store.

They work shifts that are 24 hours straight. In 2016, the ambulance service wrote off more than $1 million in unpaid charges. Because of the costs, the county will cut the number of ambulances at the ready from three to two by July.

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HISTORY

A revolutionary collection N ATALIE P OMPILIO Philadelphia

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s the nearly 12-minute film detailing its historical importance draws to a close, the tent that served as George Washington’s home and headquarters during the American Revolution appeared in silhouette behind the screen. As the music swelled, the linen structure present at the birth of the nation was revealed.

“Today, Washington’s tent is here, still bearing witness, reminding us of times when the nation’s future hung in the balance,” the narrator intoned. “The tent, like the republic, survives. It remains a symbol of the fragile American experiment, the power of the people to secure their own freedoms.”

It’s an engrossing, dramatic moment, this reveal of the crown jewel in the collection of Philadelphia’s new Museum of the American Revolution. The object of awe is a fragile, yellowing textile with scalloped trim, but oh, the stories it could tell.

“We had 50 Boston fourthgraders here in the tent theater for a test audience, and when the tent started to be revealed and you saw the scrim, they started grabbing each other and pointing. When the lights came up on the tent, they broke into applause and cheered,” said R. Scott Stephenson, the museum’s vice president of collections, exhibitions and programming. “I actually had tears in my eyes because I felt it rush through me.”

The first museum devoted to the country’s earliest years opened this past Wednesday, the anniversary of the opening battles of the American Revolution at Lexington and Concord and “the shot heard round the world” on April 19, 1775. It stands in “America’s most historic square mile,” a few blocks from the Liberty Bell, the first White House and Independence Hall, where the Declaration of Independence was signed and the U.S. Constitution ratified.

While there are dozens of mu-

BLUECADET

The new Museum of the American Revolution is the first devoted to the country’s earliest years seums and historical areas that touch on elements of the American Revolution, most focus on one battle or one person, Stephenson said. There’s long been a need for a single museum that would offer a complete account of this crucial period, one that would not compete with the other sites but would fuel interest in the shared topic.

“As Benjamin Franklin said in 1776, ‘We must all hang together or we will surely hang separately,’ ” Stephenson said. “It’s a big global story, but Philadelphia is a place where all those threads cross.”

While some may think that the success of Broadway’s “Hamilton” was the driving force behind the museum, the show had its stage debut in 2015 and Stephenson has been involved in this project for more than 10 years. In fact, many of the core exhibition items come from the collection of the Rev. W. Herbert Burk, who began advocating for a museum to honor Washington in the early 1900s.

Still, “Hamilton” has been a gift to the museum, Stephenson said,

noting how the fourth-graders who applauded Washington’s tent also ran through the exhibition singing the show’s songs and pointing out familiar faces and scenes. The museum’s location, on the site of a former National Park Service building, is also fortuitous: across the street from the First Bank of the United States, which Hamilton founded, and a restaurant called the Little Lion, which was one of Hamilton’s nicknames.

“It’s prepared this huge audience to receive this museum when they would have been arriving cold and without points of reference,” Stephenson said. “It acknowledges that there’s complexity, that it’s messy, that these were not demigods the likes of which we’ll never see again.

When you know the real story, you realize there are Alexander Hamiltons among us today.”

The entire project received $30 million in state grants but the rest of its funding has come from corporate and private donors, including a $50 million gift from founding chairman H.F. “Gerry”

A reproduction of a privateer ship is among the exhibits at the Museum of the American Revolution, which opened to the public Wednesday. The Philadelphia museum is set in “America’s most historic square mile,” a few blocks from Independence Hall and the Liberty Bell.

Lenfest and $10 million from the Oneida Indian Nation. The $120 million building includes 16 galleries and two theaters taking up 32,000 square feet, as well as a cafe and shop.

Exhibition items include a Revolutionary War cannon, a pair of bootees made from the red jacket of a fallen British soldier for an American baby, and a mug from the 1770s that still smells of rum.

After seeing a video re-creation of men pulling down a lead statue of King George III on horseback in New York in 1776, visitors can see large chunks of the statue that still exist and learn that the rest was transformed into 42,000 musket balls referred to as “melted majesty.”

The museum encourages visitors to approach its exhibits with four questions in mind: How did people become revolutionaries?

How did the revolution survive its darkest hours? How revolutionary was the war? What kind of nation did the revolution create?

“We’re trying to emulate science museums. They’re a little bit better at asking questions, like ‘Are dinosaurs more like reptiles or like birds?’ They’ll involve you in the scientific process,” Stephenson said. “So often history museums in the past have been ‘fact, fact, fact, tea cup, fact, painting, fact, fact,’ as if history is something you just gather up and put on display.”

The museum wants to tell a deeper story, which means acknowledging that even heroes had flaws. Washington often shared his tent with an enslaved African who served as his valet.

Native American tribes that chose to support Washington’s Army did so believing that they would be treated well in victory.

Free Africans did the same with the same misperception.

“People are hungry for more complicated stories about the past. The alternative has been that history is either a sermon or a bummer,” Stephenson said.

“Here we ultimately hope we’re telling a story that will be uplifting.” n ©The Washington Post

SUNDAY, APRIL 23, 2017

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KLMNO WEEKLY

The new food trend is literal garbage BY

C AITLIN D EWEY

F

lour milled from discarded coffee fruit. Chips made from juice pulp. Vodka distilled from strawberries that nobody seems to want.

At one point not so long ago, such waste-based products were novelties for the Whole Foods set.

But in the past three years, there’s been an explosion in the number of start-ups making products from food waste, according to a new industry census by the nonprofit coalition ReFED. The report, which was released Tuesday and tracks a number of trends across the food-waste diversion industry, found that only 11 such companies existed in 2011.

By 2013, that number had doubled, and ReFED now logs 64 established companies selling ugly-fruit jam, stale-bread beer, and other “upcycled” food products.

The companies have diverted thousands of pounds of food waste from landfills, a major source of greenhouse gas emissions. They’ve also become a model for larger, multinational food companies, which are starting to realize that upcycling peels and piths can be good business.

“What was once considered ‘waste’ — or an accepted cost of doing business — is now seen as an asset and revenue generator,” said Chris Cochran, the executive director of ReFED. “As companies begin to track, measure, and understand food loss and waste, the economics of food waste solutions begin to look a lot more attractive.”

Dan Kurzrock, the 27-year-old co-founder of San Francisco startup ReGrained, suspected that from the beginning. As a college home-brewer, making beer in his garage, Kurzrock noticed that a whole lot of nutritionally valuable “spent grain,” mostly barley, gets thrown out.

Kurzrock and his business partner, Jordan Schwartz, spent the next five years testing possible uses for it. In 2016, they formally launched a line of snack bars made from almonds, oats, quinoa

JEAN-SEBASTIEN EVRARD/AGENCE FRANCE-PRESSE VIA GETTY IMAGES

More start-ups are beginning to take food waste and turn it into products such as ugly-fruit jam and grains sourced from urban brewers.

“We’re a food business with an environmental and social mission,” Kurzrock said. At times, reconciling the two has been a challenge.

“Our business is about tackling waste — but how do we do that without grossing people out?” He asked. “That’s been part of the complication of dealing with this issue . . . although it seems like perceptions have shifted.”

On the other side of the country, in Providence, R.I., 55-year-old Erika Lamb has seen similar trends.

Her year-old start-up, SecondsFirst, sells fish cakes made from “ugly” produce and “underappreciated” seafood, like skate wing and dogfish. Lamb, who had previously volunteered with a local agriculture group, was surprised by the amount of produce farmers plowed into the ground or fed to pigs, given increasing consumer demand for healthy, local food.

For solutions, she turned to a classic New England recipe —

which she now sells to nursing homes, soup kitchens and schools.

“For university students especially, it’s a big draw to use food waste now,” Lamb said. She’s already looking to expand into the retail market.

Individually, of course, neither ReGrained nor SecondsFirst is moving the national needle on waste. According to the Environmental Protection Agency, Americans threw away 38 million tons of food in 2014 alone — much of it unbought, unmarketable or unharvested food that was still perfectly edible.

Lamb, who sources directly from area farmers, doesn’t track the amount of waste that she uses.

But her focus is decidedly smallscale and local: She’s determined to keep her prices low, particularly for institutions that serve lowincome people.

Kurzrock, meanwhile, puts his impact in these terms: ReGrained sources from five breweries, each of which brews three to five times per week. The company can use the

Americans threw away 38 million tons of food in 2014, according to the Environmental Protection Agency — much of it unbought, unmarketable or unharvested food that was still perfectly edible.

equivalent of one day’s brewing waste, from one brewery, weekly.

“It’s a very small amount of the total amount of waste,” he said.

“We’re really just scratching the surface.”

This does not discourage foodwaste enthusiasts, though, who argue that Lamb’s and Kurzrock’s real impact may be behind the scenes. Large, multinational food companies are paying close attention to the business models developed by upcycling start-ups, said Jonathan Deutsch, a professor of culinary arts and food science at Drexel University.

Deutsch’s lab works directly with some of these firms, helping them develop new products and recipes from their waste. Most recently, he and his students have partnered with Love Beets to dream up good uses for the company’s beet flour, such as enriched red velvet cakes. The flour is a powder made from the ground, dehydrated peels and scraps of the company’s main product — packaged beets peeled, cut and sold around the world.

There wasn’t always a market for products like beet flour, Deutsch said. But start-ups have been critical in building that market — largely by convincing customers that “food waste” was a virtuous, and not a gross, ingredient.

“We’re at this phase where there are now proven models, and a lot of interest and excitement,” Deutsch said. Many companies, he added, are “going into their factories and looking at the nutrition they put in the garbage or the compost bin, and seeing if they can get it on shelves.”

That sort of mainstream change could make a big dent in the foodwaste problem, ReFED estimates.

In a 2016 report, the coalition calculated that “upcycling” efforts could save 102,000 tons of food from landfills each year.

Until that point, however, startups like ReGrained and SecondsFirst are eager to lay the early groundwork.

“There are lots of applications for spent grain,” Kurzrock said. “...

We’re just getting started.” n ©The Washington Post

SUNDAY, APRIL 23, 2017

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BOOKS

Super-rich philanthropy is shaping our world N ONFICTION

l

REVIEWED BY

R OBERT G . K AISER

T THE GIVERS Wealth, Power, and Philanthropy in a New Gilded Age

By David Callahan Knopf. 343 pp. $28.95.

homas Piketty’s “Capital in the Twenty-First Century,” published in 2014, explained modern inequality in capitalist countries, but it was a rather dry exercise that relied heavily on numbers. In “The Givers,” David Callahan brings inequality to life. He draws a startling picture of the astounding growth of private American wealth in the past quarter-century, the people who have accumulated it and the ways they are using their money, often aggressively, to change the world — sometimes for the better, sometimes not.

Callahan’s account of how the rich exercise power in modern America is ominous and grim, though he avoids drawing the darkest conclusions his evidence would support. He admits only to being “troubled” that donations of huge amounts of cash enable power to move from public institutions “into private hands” of people whose influence can make them “supercitizens.” He acknowledges that “after three decades of rising inequality” in America, “it’s unnerving to watch rich people, however smart or well meaning, amass even more power.” He’s worried that giant endowments of family foundations will allow this power to be inherited by generation after generation.

“There may be no better way for the super-rich to ensure lasting clout for their heirs than to dedicate their wealth to philanthropy.”

Many readers of Callahan may draw harsher conclusions than he does about a system funded by all of us (through the tax deductions Americans can take when donating money to philanthropic causes) that empowers only a few of us to spend vast sums to advance favorite causes and, often, to preserve their own status atop American society. Under our lax and laxly enforced tax laws, those causes can be controversial and entirely political, and still be tax-deductible. The Koch brothers, George Soros and many more get large tax deductions for contributions that are obviously political.

ED ZURGA/EUROPEAN PRESSPHOTO AGENCY

Warren Buffett, left, and Bill Gates have persuaded others to pledge to donate at least half of their fortunes.

The starting point of “The Givers” is a powerful description of how much wealthier and more numerous the richest Americans have become just in the past generation. “Rich” is not what it used to be. I remember when J. Paul Getty, the oilman, was the archetypal rich American, in a class by himself.

When Getty died in 1976, he left an estate of about $8 billion in today’s dollars. A fortune of $8 billion today would rank 55th on Forbes Magazine’s list of the 400 wealthiest Americans. Forbes credits Bill Gates, first on that list, with a personal fortune of $81 billion — 10 times Getty’s wealth. Everyone on Forbes’s top 20 is worth more than $20 billion.

In Getty’s day, great wealth was rare; today it’s more commonplace.

Forbes identifies 540 American billionaires. Callahan reports that 70,000 Americans are worth more than $30 million. Five thousand American households have assets worth more than $100 million — without counting their real estate.

They are a diverse group, but Callahan argues persuasively that a common thread now connects many, probably most, of them: They believe in charity. Giving away vast quantities of money is a status symbol for the super-rich.

Callahan quotes Michael Bloom-

berg (net worth: $45 billion) on the subject of great wealth: “You can’t spend it, and you can’t take it with you.” Concludes Callahan, “Philanthropy is the only real place the money can go.”

Since 2000, wealthy Americans have created 30,000 new foundations and 185,000 “donor-advised funds,” a way for the wealthy to pool their resources without going through the complicated process of establishing a foundation. This trend is likely to continue.

And of course, a lot of the resultant philanthropy has been a boon to many American communities.

We have countless new museums, enriched schools and colleges, medical research laboratories, foreign assistance projects, and much more thanks to the creative efforts of the best philanthropists.

We’ve also had bitter controversies over charter schools, teacher tenure, gun control and many more issues fueled by philanthropic efforts to change the country. And there is room for resentment. As Callahan writes, “The more active the rich have become in injecting their money and preferences into public life, the less that ordinary people may feel that they can compete and the more they may tend to withdraw.”

Gates is the leading example of

the new philanthropists who are Callahan’s subject. The founder of Microsoft and his wife, Melinda, have richly endowed the Gates Foundation, with help from their friend Warren Buffett. Its assets today are nearly $40 billion. In the 16 years it has existed, the Gates Foundation has given away more than $37 billion, but this is only a modest first step. The Gateses are committed to giving most of their fortune to the foundation, which means it will have perhaps $150 billion to distribute in the years ahead. Already the Gates Foundation has helped control the AIDS epidemic in Africa, reduce malaria, create the Common Core school curriculum and a great deal more.

Callahan, creator of the online publication Inside Philanthropy, is not a great writer. But he has performed a public service by assembling a striking body of information on a fundamental aspect of 21st-century America, a century when the wealth of the average family has stagnated while the wealth of the rich has soared. n Kaiser is a former managing editor of The Washington Post and author of “So Much Damn Money: The Triumph of Lobbying and the Corrosion of American Government.” He wrote this for The Post.

SUNDAY, APRIL 23, 2017

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BOOKS

KLMNO WEEKLY

In London, a fugue is a prelude to terror

Finding humanity in mental illness

F ICTION

N ONFICTION

Y

l

REVIEWED BY

R ON C HARLES

es, the publishing industry is growing more concentrated, and, yes, the bestseller list tyrannizes readers’ choices, but despite those alarming trends, all is not lost. The chorus of modern fiction remains reassuringly open to new voices.

Without any design on my part, I’ve now reviewed three debut novels in a row, a small sampling of extraordinary new talent that should encourage anyone concerned about the health and diversity of our literary culture.

“Underground Fugue,” by Margot Singer, is a story about grief and race punctuated by the 2005 bombings in London.

Singer’s novel travels up and down the scale of sorrow, reflecting the musical and psychological connotations of her title. The epigraph is a quotation from Glenn Gould describing Bach’s “The Art of Fugue”: “For me, these pieces contain an endless range of gray tints.” That subtle palette perfectly reflects this haunting story, too, which feels suspended in a murky state between memory and presence, happiness and despair.

At the opening, an American woman named Esther arrives in London to care for her dying mother, Lonia. Despite her best intentions to be strong, the hospice setting disturbs Esther, who is still in shock over the death of her teenage son — one fresh loss bleeding into the next.

That plot wouldn’t seem to promise much movement, but next door, life persists: A British Iranian brain scientist lives with his son, a college student fond of “urban exploration.” Unbeknown to his father, he and his buddies go spelunking in “storm drains, utility tunnels, conduits, construction cranes” — the neural networks of London.

The chapters rotate through these four characters, though Esther remains primary. It’s her plight that dominates the novel, her struggle to cast off the enervating blanket of grief.

Capturing the stasis of mourning in a compelling way is more treacherous to pull off than it looks. Only the quiet, humble beauty of Singer’s prose keeps these sections aloft, but that’s sufficient.

Surprisingly, given her proximity to the undiscovered country, much of the novel’s drama comes from Lonia on her deathbed.

Clouded by morphine, her thoughts drift back more than half a century to those harrowing months when she and her brother fled from the Nazis, leaving their family behind in Czechoslovakia.

Those World War II scenes contribute to the novel’s contrapuntal treatment of racial violence. For the elderly Jewish women who come to visit Lonia, the Holocaust is still a fresh and ever-present threat. This time, though, the aggressors are Islamic terrorists, who have already destroyed the twin towers in New York and threaten to strike again.

It’s in this climate of fear and suspicion that Esther meets that charming Iranian scientist next door. Might he be the person to draw her back to life? Perhaps, but Singer carefully marks the dates so that we anticipate with swelling dread the atrocity that will rip London apart — the same sense of doom that hangs over so many novels set in New York during the summer of 2001.

Singer has won a Flannery O’Connor Award for her short stories, and her skill with that concentrated form is evident in this book’s perfectly formed chapters.

Indeed, the parts of “Underground Fugue” are somewhat better than the whole. By the end, it seems to dissipate rather than achieve the piercing sense of longing that so powerfully concludes many of its smaller sections. But good endings, like good deaths, are rare.

That shouldn’t keep anyone from being moved by the tenacious spirit of this novel. n Charles is editor of The Washington Post’s Book World.

A

UNDERGROUND FUGUE

By Margot Singer Melville House.

290 pp. $25.99.

NO ONE CARES ABOUT CRAZY PEOPLE The Chaos and Heartbreak of Mental Health in America

By Ron Powers Hachette.

360 pp. $28.

l

REVIEWED BY

D AMON T WEEDY

s a young medical student, I learned about schizophrenia mostly by keeping my distance, both literally and figuratively. I’d never encountered a person with the disorder (that I knew of ) before my six-week rotation at a state psychiatric hospital, and I’m not proud to admit that these men and women — tortured as they were with paranoid thoughts and scary voices that only they could hear — somehow seemed less than human to my 23-year-old eye.

It’s this mixture of fear and indifference, widespread in our country, that author Ron Powers boldly confronts in his heartwrenching new book, “No One Cares About Crazy People.” Powers, a Pulitzer Prize-winning journalist and successful nonfiction author (“Flags of our Fathers,” “Mark Twain: A Life”), comes at this subject first and foremost from a personal vantage point. His younger son, Kevin, received the diagnosis as a teenager, and despite a few brief periods of hopeful calm, he ultimately succumbed, killing himself shortly before his 21st birthday. A few years later, Powers’s older son, Dean, was also diagnosed with schizophrenia, and after many hospitalizations and treatments, he has now reached a point of relative stability. Still, his life is far different from where it seemed headed during his adolescence.

This family odyssey, one Powers travels with his wife, Honoree, could have stood alone as a book itself, taking its place in the genre of memoirs on mental illness. Instead, Powers draws on his journalistic talents to explore the past and present landscape of mental health treatment in the United States. We learn crucial details about the widespread closure of psychiatric hospitals through the 1960s and 1970s, the limitations of antipsychotic medications, and the inability of an underfunded public mental health system to care for the chronically sick. Pow-

ers persuasively asserts that these forces have led to rising rates of homelessness and incarceration among the mentally ill, where they “live under conditions of atrocity.”

In the midst of this sweeping overview, Powers gives us powerful stories of real suffering and societal apathy toward the plight of our fellow citizens. Their struggles must not be forgotten as we continue to debate reforming our health-care system.

While the book offers much to contemplate about mental health treatment on a larger scale, many readers will be most drawn to Powers’s personal story, which is interwoven throughout the narrative.

Powers poignantly uses Kevin’s and Dean’s journeys to illustrate how those with mental illness are “people who have known love, laughter, inventiveness, hope and the capacity to dream the same dreams of a future that other people dream.” On a personal level, he doesn’t want his sons defined only as a psychiatric illness, or in Kevin’s case, by his final act. In that respect, the book is, among other noble goals, Powers’s effort to preserve his sons’ humanity.

Powers concludes that the future of mental health in the United States is being shaped along two trajectories: a flourishing research enterprise juxtaposed with a chaotic system of delivering care.

Part of the chaos stems from our limited ability thus far to translate brain research data into the diagnosis and treatment of people with psychiatric illness. But another element is related to the fear and apathy that continue to surround the subject. To this end, Powers hopes his story will have an impact: “I hope you do not ‘enjoy’ this book,” he writes. “I hope you are wounded by it; wounded as I have been in writing it. Wounded to act, to intervene.” n Tweedy is an assistant professor of psychiatry at Duke and author of “Black Man in a White Coat.” He wrote this for The Washington Post.

SUNDAY, APRIL 23, 2017

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OPINIONS

Facebook lets streams of depravity flow freely MARGARET SULLIVAN is the media columnist for The Washington Post.

Facebook’s existential crisis arrived with a vengeance this week. But Mark Zuckerberg didn’t want to talk about it much.

Yes, as he took the stage Tuesday in San Jose for his keynote address at a Facebook conference, he nodded to what had happened just two days before: A coldblooded killing posted for millions to see, with live-streamed commentary from the killer soon after.

“Our hearts go out to the family and friends of the victim in Cleveland,” Zuckerberg said.

“We’ll do all we can to prevent tragedies like this from happening.”

But then Facebook’s founder and chairman dived right into an extended discussion of the next Facebook frontier — augmented reality, which integrates digital information with the user’s experience in real time.

His mention of the killing, while seemingly sincere, still felt like a kiss-off.

But it’s not surprising. Denial is, far too often, the Facebook way.

Remember just after the presidential election when Zuckerberg shrugged off the importance of the hyperpartisan lies in the form of news stories — like Pope Francis supposedly endorsing Donald Trump?

“Personally I think the idea that fake news on Facebook, which is a very small amount of the content, influenced the election in any way — I think is a pretty crazy idea.”

In time, he changed his mind about that, and Facebook, to its credit, has made some significant moves to flag, limit and remove financial incentives for lies and misinformation that spread like a disastrous oil spill during the campaign.

But Facebook still hasn’t come to terms with what it really is — a media company where people get their news and which, especially

because of the year-old Facebook Live, generates news content.

Since it began, rape, a horrible attack on a disabled teenager, and more than one suicide have been live-streamed.

“The crux of this is what is Facebook’s true nature: a technology that enables anyone to publish anything? Or a selfregulating media company with enforced standards?” Emily Bell, director of the Tow Center for Digital Journalism at Columbia University, told me Monday evening.

Facebook’s answer became clear Tuesday morning.

With its nearly 2 billion monthly active users and more than $10 billion in annual profits, Facebook is better at making money and capturing eyeballs than at owning its equally huge power and responsibilities.

David Clinch, global news editor of the verification site Storyful, put it this way: “They have to take this issue very seriously and deal with it urgently, or they will surely face more calls for Facebook Live to be put on hold until far more robust controls are put in place.”

So far, that’s not happening.

In recent months, Facebook has gone out of its way to avoid acknowledging the obvious: It is a media company, not simply a platform for its billion-plus users to share their lives with family and friends. (I called last year for the company to hire an executive editor, as one step, partly a

STEPHEN LAM/REUTERS

During Facebook’s conference last week, founder and chief executive Mark Zuckerberg spoke only briefly about the live-streamed killing.

symbolic one, in that direction; that was shortly after a Pulitzer Prize-winning photograph was deleted by Facebook, which saw its depiction of the famous Vietnamese napalm girl not as art but as child pornography.)

But there are, of course, business reasons not to accept that. As soon as Facebook acknowledges that it is a publisher and not a platform, it may open itself up to lawsuits that could cut into profits fast.

Better, the thinking apparently goes, to stress technological advances and the ability to connect the whole world with virtual reality, baby pictures and exploding watermelons.

And its Facebook Live has been a force for good, too. Last year, Diamond Reynolds live-streamed the police shooting in Minnesota of her boyfriend, Philando Castile. It was an important piece of bearing witness, made poignant by the presence of Reynolds’s tiny daughter.

At this crucial moment, Facebook’s language often sounds clueless, with its combination of stilted corporate euphemism and childlike wonder about “community” and “sharing.”

After the Cleveland slaying, which remained on the site for hours, a Facebook statement put it like this: “This is a horrific

crime and we do not allow this kind of content on Facebook.”

Later, a Facebook vice president made a seemingly more thoughtful effort to describe the ways the company would use artificial intelligence and a better “reporting flow” to address the problem.

But none of this was specific enough, or serious enough. Nor did Zuckerberg’s brief mention help.

As Clinch wrote on Twitter: “There’s no algorithm for this and there is no cheap way to do this with community monitoring and inexperienced staff.”

Facebook is immensely and increasingly profitable — it made more than $10 billion last year, up dramatically from 2015. More than four of every five dollars comes from mobile ads, which makes video more and more essential to corporate success.

But this can’t go on forever.

Bell summed it up: “If Facebook is really interested in the unbiased nature of discourse it would know that totally unmoderated systems favor the authoritarian bully, and suppress free speech rather than enable it.

Ask Twitter.”

An innocent man and his killer — who committed suicide Tuesday — are dead. But that can’t be the end of the story. n

SUNDAY, APRIL 23, 2017

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OPINIONS

KLMNO WEEKLY

TOM TOLES

The appeal of ‘Medicare for all’ CATHERINE RAMPELL is an opinion columnist at The Washington Post.

Despite the rise of the tea party and unified Republican control of government, one decidedly anti-free-market idea appears ascendant: single-payer health care.

And it’s no wonder, given that a record-high share of the population receives government-provided health insurance. As a country, we’ve long since acquiesced to the idea that Uncle Sam should give insurance to the elderly, veterans, people with disabilities, poor adults, poor kids, pregnant women and the lower middle class.

Many Americans are asking: Why not the rest of us, too?

A recent survey from the Economist-YouGov found that a majority of Americans support “expanding Medicare to provide health insurance to every American.” Similarly, a poll from Morning Consult-Politico showed that a plurality of voters support “a single payer health care system, where all Americans would get their health insurance from one government plan.”

Views of a health-care system in which all Americans get their insurance from the government single payer vary a lot depending on how you frame the question.

Calling it “Medicare for all,” for example, generally elicits much stronger approval, while emphasizing the word “government” tends to depress support.

But at the very least, some survey questions that have remained consistent in recent years show support has been rising back up over the past few years for the broader idea that the federal government bears responsibility for making sure all Americans have health-care coverage.

In a way, stronger public support for single payer is the logical conclusion of recent healthinsurance trends.

Since 1987, the share of Americans who receive some sort of public insurance has roughly doubled, to about 4 in 10 as of 2015. That’s not even counting the people who receive subsidies to buy private insurance on the Affordable Care Act exchanges.

The increase in the share of Americans on government insurance is partly due to

demographics (baby boomers aging into Medicare) and partly due to deliberate policy changes growing the pool of Americans eligible for government insurance (such as the creation of the Children’s Health Insurance Program and Obamacare’s Medicaid expansion).

Expansions of government coverage have been cheered on by many liberals, but they have also bred suspicion and jealousy.

In both the recent YouGov and Morning Consult polls, for example, the age group most opposed to single payer was the only one that basically already has it: those 65 and up. Seniors are probably worried that expanding government coverage to more Americans could put their own generous benefits at risk.

Many of those not among the growing pool of public-insurance beneficiaries, on the other hand, have become resentful of the fact that everyone else seems to be getting a big fat government handout. Or so they perceive.

Many of the stories in the booming “blue-state reporter ventures into Trump country” genre have featured Trump supporters with deep hostility toward Obamacare, among other government programs. Some of these Trump supporters are, perhaps

puzzlingly, themselves Obamacare beneficiaries, receiving government subsidies for private insurance on the individual exchanges. But often what these Trump voters say they want is not a return to preObamacare days; rather, they want in on the great insurance deal that they think their lazy, less-deserving neighbors are getting.

In fact, that recent YouGov poll found that 40 percent of Trump voters support expanding Medicare to all Americans. Among Republicans overall, the share rises to 46 percent.

Among Republican politicians, needless to say, attitudes are somewhat different. Expanding public health coverage to more people costs a lot of money, which doesn’t exactly jibe with their taxcutting agenda.

Even Democrats don’t have the stomach for the battle required to replace our jury-rigged, mostly employer-sponsored insurance system with single payer. Which is understandable — while I also favor universal health-insurance coverage, I’m skeptical it will be achieved through single payer, given both the state of our political process and Americans’ cultural allergy to tax hikes.

Even so, somewhere out there, Bernie Sanders is smiling. n

SUNDAY, APRIL 23, 2017

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OPINIONS

WASSERMAN FOR THE BOSTON GLOBE

Syria, N. Korea pose cyberthreat TED KOPPEL is the author of “Lights Out” and senior contributor to “CBS Sunday Morning.” He wrote this for The Washington Post.

As the Trump administration confronts the nuclear ambitions of North Korea’s Kim Jong Un and the toxic fallout from Bashar al-Assad’s chemical warfare against Syrian civilians, it is worth remembering that both dictators also command cyber-units. On the face of it, their impact is significantly less lethal, and they can easily be underestimated.

At the extreme, cyberattacks can have a devastating impact. China, Russia and (it must be noted) the United States have already planted cyber landmines within the control systems that regulate each nation’s infrastructure. The complexity of the relationships among these three nations, however, makes it highly unlikely that any of them would unleash its most powerful cyberweapons on the others. It is notable that no such constraints exist between the United States and either Syria or North Korea.

Neither walls nor extreme vetting are of much use against cyberwarfare. It is an enormously flexible weapon system, with a range from bothersome to devastating. It empowers the weak and exposes the vulnerabilities of superpowers.

The United States, because of its extraordinary dependence on the Internet, may be the most vulnerable of all nations.

Take, for example, the cybertantrum that Kim allegedly inflicted on Sony Pictures Entertainment in 2014.

Predictably infuriated by the company’s production of “The Interview,” a comedy predicated on the planned assassination of

Kim by a pair of American TV journalists, the North Korean leader appears to have exacted his revenge by ordering the takedown of Sony Pictures’ corporate computer system.

It remained inoperable for an extended period. Budgets and executive and superstar compensation packages were made public. The hackers claimed they had more than 100 terabytes of Sony Pictures data and warned the company against releasing the film. The intimidation worked for several weeks; then Sony Pictures, publicly chastened by First Amendment advocates and President Barack Obama for

MIKE LESTER FOR THE WASHINGTON POST WRITERS GROUP

failing to uphold freedom of speech, distributed the film to more than 300 theaters.

Sony Pictures had made enormous investments in cyberprotection, including no fewer than 42 firewalls. The failure of that system underscored one of the fundamental rules of cyberwarfare: A determined offense almost always defeats defense. A stratagem effectively employed against a large and cyber-conscious company could also be successfully directed against critical U.S. infrastructure.

Then there is the intriguing case of the Syrian Electronic Army, which claimed responsibility for hacking into an Associated Press Twitter account.

On April 23, 2013, that account put out an erroneous tweet: “Breaking: Two Explosions in the White House and Barack Obama is injured.” Within a matter of minutes, AP issued a correction, by which time, however, $136 billion in equity market value had been erased. The market recovered in short order.

In what may have been an extraordinary coincidence, the attack came just at the time that the Obama White House sent letters to Sen. John McCain (RAriz.) and then-Sen. Carl Levin (D-Mich.) stating the following:

“Because of our concern about the deteriorating situation in Syria, the president has made it clear that the use of chemical weapons — or transfer of chemical weapons to terrorist groups — is a red line for the United States of America.”

What may indeed have been a juvenile piece of childish vandalism — that is, the phony AP tweet — could also have been a far more sophisticated warning from Syria: Assad drawing his own “red line.” A friendly reminder that if an easily discernible and correctable hack into a Twitter account can produce a $136 billion plummet in equity market value, it might be useful to consider what a more refined attack on the U.S. banking system could do.

Whatever the rationale, the Obama administration never took military action against Syria. As President Trump considers his options against Syria and North Korea, his advisers would do well to remind him that cyberwarfare has a way of leveling the battlefield.

Not as alarming as the specter of a North Korean intercontinental ballistic missile armed with a nuclear warhead, nor as worrisome as chemical or biological terrorism. But easier to carry out and much more likely. n

SUNDAY, APRIL 23, 2017

23

KLMNO WEEKLY

ON LEADERSHIP

Want a better CEO? Try an introvert.

BY

J ENA M C G REGOR

T

he image most people have of a straight-fromcentral-casting CEO is usually something like the following: An extroverted, charismatic, confident executive who climbed a mistake-free ladder to the top with a degree from an elite school.

But a new 10-year study from a leadership advisory firm and economists from two business schools, published in this month’s Harvard Business Review, finds that the most successful chief executives often don’t fit that mold.

The researchers behind the study, called the CEO Genome Project, used a database of assessments — comprehensive performance appraisals and extensive biographical information — of 17,000 C-suite executives, including 2,000 CEOs. The database, created by the consultancy ghSmart, includes everything from career history to behavioral patterns to how the executives performed in past jobs, decisions they’ve made and demographic information.

Their analysis, which included help from statisticians, data scientists and financial analysts, examined a sample of 930 of those CEOs to come up with the traits and patterns that most predicted which ones became a CEO. They also gathered information on the performance of 212 of them to compare how top-performers’ behaviors lined up with the traits that tend to get CEOs hired.

What they found surprised them. A little more than half of the CEOs who did better than expected in the minds of investors and directors were actually introverts, not the usual gregarious CEOs known for glad-handing customers.

“The biggest aha, overall, is that some of the things that make CEOs attractive to the board have no bearing on their performance,” said Elena Lytkina Botelho, a partner at ghSmart and

a co-founder of the project. “Like most human beings, they get seduced by charismatic, polished presenters. They simply do better in interviews.”

Botelho says she doesn’t necessarily think introverts are always better performers but that they may be more prevalent, and do better in her sample, because boards are so attracted to them.

“I've been in the room and had directors express the concern — ‘this person is such a strong introvert, how will they really lead?’ ” she said. Similarly, candidates who displayed a lot of confidence had more than double the chance of being chosen as CEO, the study found, even though particularly confident CEOs were no more likely to show better performance once they got the job.

Meanwhile, only 7 percent of the best-performing CEOs — who ran companies from Fortune 10 behemoths to those with just

A little more than half of the CEOs who did better than expected were actually not the usual gregarious CEOs known for gladhanding customers.

$10 million in annual sales — had an Ivy League degree, despite the conventional wisdom that pedigree matters. “There was zero correlation between pedigree and ultimate performance,” she said, acknowledging that number could be higher if they were just looking at large Fortune 500 firms.

Another misconception boards make when picking their next CEO is to choose candidates who have an impeccable career trajectory, with nothing but a résumé full of achievements lining their path from MBA to the boardroom. But nearly all of the executives in their sample who were candidates for a CEO job had some kind of major mistake, the project found, such as overpaying for an acquisition or making a wrong hire, in their assessment.

Nearly half of them also had what the researchers called a career “blowup” that pushed them out of a job or cost the business a

JRCASAS/GETTY IMAGES/ISTOCKPHOTO

large amount of money — and three-quarters of that group went on to actually become a CEO. So what did make CEOs successful? After analyzing all of their data, the researchers found that roughly half of the candidates earning an overall A rating in their database, when evaluated for a CEO job, had distinguished themselves in more than one of four management traits. (Only 5 percent of the weakest performers, meanwhile, had done the same.) The four were: reaching out to stakeholders; being highly adaptable to change; being reliable and predictable rather than showing exceptional, and perhaps not repeatable, performance; and making fast decisions with conviction, if not necessarily perfect ones.

Indeed, that last trait — a willingness to make a call quickly, even without all the needed information — was one of the four “essentials” Amazon CEO Jeffrey P. Bezos, who also owns The Washington Post, detailed in his own letter to shareholders this month. Calling it “high-velocity decision-making,” Bezos wrote that “most decisions should probably be made with somewhere around 70 percent of the information you wish you had. If you wait for 90 percent, in most cases, you’re probably being slow.” Being wrong isn’t always so bad, he wrote. “If you’re good at course correcting, being wrong may be less costly than you think, whereas being slow is going to be expensive for sure.”

Botelho agreed that first trait was the most surprising. “We frankly expected to find that strong CEOs stood out for the quality of their decisions — that they turn out to be right more frequently,” she said. “But what very clearly stood out was the speed. Quality was likely something they developed earlier, but then they’re willing to step up and make the decision faster, even with more uncertainty.” n ©The Washington Post

SUNDAY, APRIL 23, 2017

24

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